Occupational Therapy in Paediatrics within Community Health



Occupational Therapy in Paediatrics within Community Health

SLIDE 1During my placement at Community Health, I have been researching the possible scope for the role of a paediatric OT within the current child health team. To get an accurate picture of what exists within the Sunshine Coast district. I have been observing and taking part in one- on- one sessions and group sessions. This involved speaking to and visiting numerous child health related services. These were based on the Sunshine Coast and Northlake’s Community Child Health team, whom have Occupational therapists within their team. The services that were visited or phoned were:

• Nambour community health’s Paediatric OT Di Collis

• Nambour hospitals paediatric allied health team

• DSQ’s Family and Early Childhood service

• Education Queensland

• Sunshine Coast Children’s Therapy Centre

• AEIOU

• Montrose Access

• Autism Queensland

• Cerebral Palsy League

• Spina Bifida and Hydrocephalus Association

• Private OT services on the Sunshine coast

• Northlake’s Child Community Health OT

With this research it, has become apparent to me that Occupational therapy services within Community health on the sunshine Coast is a .2 position, with one OT, one day a week.

What Community health offers?

SLIDE 2Currently, in the Caloundra Community child health team a free health service is provided to families of children aged 0-8 years within the region. SLIDE 3The service offers health professionals such as Child health nurses, a Speech Pathologist, an Early Intervention Parenting Specialist, an Occupational therapist, Dietician and Physiotherapist through the mend program and a social worker. SLIDE 4 The Child health nurses provide

• prenatal parenting classes

• neonatal screening

• Assessments of feeding issues and information on breastfeeding

• baby’s first visit

• individual consultations

• hearing screens

• information sessions for parents of young babies, babies of 6 months of age and 12-15 months of age, including development, nutrition and behaviour

• parenting programs such as triple

SLIDE 5The Early Intervention program is run by the social worker, offering sessions in the circle of security, dealing with children with challenging behaviours, offering counseling to the parents and the child, and providing services to families of the C.A.R.E program. SLIDE 6The speech pathologist offers individual assessments as well as group sessions to children with mild, moderate and severe developmental delays. These services include:

• socializing issues

• speech issues

• problems following direction

• Children that talk slow or have a stutter

• And difficulties with eating, drinking and drooling

SLIDE 7The Occupational therapist runs a pondering poo’s program dealing with chronic constipation and toileting issues and a Physiotherapist and Dietician whom run the MEND Program, which provides specialized diets and exercise programs for children with obesity. Most of the services provided are to enable the child to be ready for schooling as part of an early intervention approach.

Other services provided on Sunshine Coast

SLIDE 8 (Click 2) The Nambour General hospital has an Allied health service within the paediatric sector. It is a free service offered to families of children from birth, which may have concerns around development, a condition affecting development or at risk of developmental delays.

The team consists of physiotherapists, occupational therapists, Speech pathologists, Dieticians, social workers and psychologists. Referral is generated from a hospital admission such as the Special care nursery, after leaving hospital by doctor’s referral or from a community health nurse. The occupational therapist Assesses how a child:

• responds to and experiences sensations

• develops fine motor and gross motor skills

• interacts, concentrates and problem solves

• develops independence in sleeping, eating, bathing and dressing

• deals with emotions

• and how the child plays independently and with others

They provide individual consultations and group therapy sessions, however are under huge demand and waiting lists are quite extensive.

(Click)Education Queensland provides specialist intervention. These services are available only within the schooling environment and the child must be assessed and meet the criteria to be eligible for intervention. A moderate to severe delay must be prevalent to gain access to this service.

(Click)Montrose Access, deal with children aged 0-18years whom are diagnosed as having physical impairment, muscular dystrophy and Rheumatoid arthritis. Children need to have a referral from a paediatrician or specialist. Typically Montrose Access offer a community based care, in home or school, individual consultations and block therapy, respite, recreational activities and allied health therapists.

(Click)Sunshine coast children’s therapy centre cater for children aged 0-18years but prioritize early intervention ages of 0-8yrs. They offer Occupational therapists, Speech Therapists, Physiotherapists and Psychologists. Children can be referred by the parent or any other person involved in the child’s life and must be requiring more than one area of therapy. Parents’s pay a yearly contribution of $500 and continue to fundraise for the organization.

(Click)DSQ’S Family and Early childhood service provide services to children aged 0-6years who are at risk of significant developmental delay or Intellectual Impairment and are residing within their catchment area. Referral can be by the parent, however the child has to be assessed and meet their eligibility criteria. They provide:

• in home care,

• a disability service centre

• inclusion into the communities schools and daycare centre’s

• specialist therapists

• education to schools, daycare centre’s and kindergartens

• and support to parents

(Click)The Cerebral Palsy league deal with children aged 0-18years diagnosed with Cerebral Palsy, sight and hearing impairment, Downs Syndrome and Fragile X syndrome. They must meet there eligibility criteria. They Provide:

• in home care

• community services

• education support and,

• allied health services

(Click)AEIOU are an early learning centre that cater for children aged 0 to 5yrs whom have normal development and children aged 2.5-5years diagnosed with Autism. The children with Autism need to have a referral from a paeditrician or psychologist and have to go through an interview and assessment process to see whether eligible. Parents have to pay for the program yearly which costs about $5000. The service offers expertise from allied health professionals and they work in a transdisciplinary setting. Basically, offering early intervention to ready these children for the schooling environment by offering an inclusive environment.

(Click)Autism Queensland provide services to children aged 0-6years whom have been diagnosed with one of the Autistic spectrum disorders, however, do not cover children of non-Australian citizenship. They provide;

• Early Intervention

• parent support

• respite and

• specialist therapies services

(Click)The Spina Bifida and Hydrocephalus Association offers services to children aged 0-18years whom are diagnosed with Spina Bifida or some form of Hydrocephalus. They provide;

• outreach services

• parent support

• liaison with medical staff and hospital clinics and

• provide equipment and home modifications.

(Click)Private services treat children aged 0-18 years in all areas of developmental delay and functional abilities, however are very costly and waiting periods are quite long.

(Click)Northlakes Child Community health offers a free health service to children aged 0-8 years. They provide specialist services that include occupational therapy, speech pathology, clinical nurses, psychology, physiotherapy and Early intervention. They run a similar program to caloundra, however have a larger number of staff and seem to see their patients on an individual basis unless the client could benefit from a number of therapies. They do run group educational programs and programs like the SOS feeding program, speech programs, developmental education to parents, and do refer to other team members where appropriate, working in a multidisciplinary focus. They also service Woody Point Special School.

What an OT does?

(Slide 9)A little bit of information about what an OT does in general. OT’s look at a person’s ability to engage in everyday meaningful occupations. These Occupation’s include; self-care tasks such as bathing, dressing and feeding, productive activities such as schooling, leisure activities such as sports and hobbies and rest such as sleeping habits. They assess and provide clients with education, strategies, development of their skills and assistive equipment to help them to engage in these occupations that may be affected by illness, disability, injury or loss of functional independence. The OT will use a biopsychosocial model along side a client and family centred approach to ensure optimal occupational performance. Occupational performance is the client’s ability to carry out the activities of importance in their everyday lives. A good way to understand how an OT works is through the Person-Environment-Occupation model (PEO) (Slide 10). The PEO model is represented by 3 circles and where the circles overlap illustrates the client’s level of occupational performance (Click). The overlap becomes bigger or smaller depending on which areas for the client may be affected. Optimally, the larger the occupational performance overlap, the more independent the client is in everyday functioning within their occupations. However, if any of these elements are affected the occupational performance fit is decreased, affecting the clients ability to engage in their occupations. All three elements affect each other, i.e. The environment will effect occupational engagement for the person, the type of occupation will effect the environment, and the person as a whole will effect the types of occupations engaged in and the environment in which they engage in. In therapy we look at all three elements and work with these to allow a larger overlap of occupational performance. The OT gathers information on the client based around these areas, looking at the attributes of the person, the types of occupations in which they engage in and the environmental contexts in which these occupations are engaged within and base there intervention around the goals of the client and making the client as functional independent in what is meaningful and relevant to them. In Pediatric OT, we generally look at how the child is developing, what milestones are being reached, and look at which one’s need improving, in order to ready them for schooling and allow optimal occupational performance. The main occupations that children engage in are self-care tasks such as eating, dressing, and toileting, play based occupations, and the school student role as a learner, and an efficient listener. In order to engage in these, children need to have good fine motor skills, gross motor skills, communication and social skills, good sensory processing skills, good attention and memory skills and effective developmental attainment overall. OT’s look at these areas and provide early intervention approaches to ensure a child will have optimal engagement in daily occupations and to ready them to be effective learners

Where an OT could fit into Community Health?

Now that I have given you a brief run down of what exists within the sunshine coast region in the way of occupational therapy services and children’s services in general. And have discussed what an OT generally looks at in Paediatrics. I am hoping that it has become apparent that there are ways an OT could be contributing to the Community child health setting in Caloundra. At the moment within community health, OT is limited to offering the pondering poo’s program catering for chronic constipation and toileting issues. However, the demand for occupational therapy services on the coast far out ways the pondering poo’s program and there are several other areas of child health and development that are not being fully met. Hence, the role an OT in child health would look as follows, and would help take the pressure off other allied health professionals within the team. Firstly, in working along side the current team in a transdiciplinary focus, an OT could work with the child health nurses(Slide 11) in several different ways. These could be through:

• an educational group to parents of infant’s run along side the development milestones group, regarding the healthy development of their children,

• by providing them with information on what milestones their babies should be reaching and at what ages, and

• ways in which they can engage their babies in play based activities to encourage the development of these milestones.

This could be done by providing an informational brochure, as well as, physically demonstrating to the parents specific activities to encourage these milestones. This if you like could also act as an early intervention approach, allowing the OT to pick up on any developmental delays early in the piece, and therefore provide one-on-one sessions where appropriate. The OT may also work along side the health nurse within their mother’s and babies group, by providing parents with education and strategies around the importance of getting their baby into a routine, developing a bond with baby early on in life and the importance of time management as well as positioning whilst feeding bubby. Another area where the OT may work along side the health nurse, would be when a health nurse carries out a hearing assessment and the child is found to have a hearing impairment, the health nurse could refer the child to an OT to work with the child and their family to develop alternate ways to communicate. For example education on the different forms of communication, the use of a visual cueing systems in the home and coping strategies for the parent and family. Similarly, the OT could work along side the Speech Pathologist (Slide 12), by providing an educational group run along side the language pronunciation and sounds groups. The OT could show parents ways of developing fine motor and gross motor skills whilst adding in an element of play to encourage communication development and cognitive development in readying their children for schooling. Whilst providing them with the best possible attainment of language. This could be done with each of the different age groups, by providing age appropriate activities. Also the speech pathologist and OT could work together to incorporate a feeding program for fussy eaters and children having difficulties with the mechanics of eating. Whilst visiting the Nambour allied health team it was suggested by one of the OT’s, that running the SOS feeding program within the community health setting would be very beneficial to developing better eating practices in children with developmental delays and normally developing fussy eaters. The SOS Program assesses and addresses factors associated with feeding difficulties. It usually runs as a ten week course for children aged 6months-5years and usually only recruits 3 children at a time. It looks at everything from positioning whilst eating, food textures, introducing new foods, nutritional values of food and requirements for children, mechanics of eating, social values around eating, messy play techniques and provides parents with strategies to cope with fussy eaters.

Similarly, an OT within community health at Caloundra could also help decrease the caseload of the patients waiting for the pondering poo’s program and even provide an informational session to parents regarding toilet training with their children and making it an easier process.

The OT could also work along side the Early Intervention Parenting Specialist/social worker (Slide 13) by offering parents education and strategies to develop a secure attachment and bonding with their children in collaboration with the circle of security, reiterating the importance this plays in their child’s development. The OT could provide an occupational perspective on behaviour management. For example a parent presents with a child that has difficulty attending to tasks and can be disruptive and over exertive towards his brothers and sisters. The OT might suggest that the behaviours being displayed are due to a sensory processing issue, where the child is seeking tactile stimulation through rough play. The OT may intervene by providing sensory processing therapy, by giving the parents ways of providing daily experiences to meet the child’s sensory needs and by adapting the environment in ways to decrease the sensory triggers.

As well as supporting the existing services, an OT could provide specific services that aren’t currently being offered (Slide 14).

A paediatric OT in community health, could also attend to the referrals covered by the adult OT’s within community health. Received from Education Queensland, parents, or doctors, for children of school age, that are not covered by any of the other services provided in the region. In general a paediatric OT in the child health team could assess children’s development in areas of fine motor skills such as writing, cutting with scissors, tying shoe laces and manipulating small objects. Gross motor tasks such as posture, balance, hand-eye co-ordination and co-coordinating both sides of the body. Their development of play based skills such as; social interaction, communication, attention and listening. There ability to deal with different information received through their environment -Sensory processing skills, and cognitive development such as memory, visual processing, and sequencing. In general the OT would assess the child and then based on observations and possibly formal assessment results, provide intervention directed at changing the person, Environment or Occupation.

After, observing a Community health Team with an OT at Northlakes, it has also became obvious that operating a community based/ out-patient service within a hospital environment is not the optimum setting to be operating in, when your focus is on being client and family centred in an accessible and relaxed environment. By placing the out-patient workload within the hospital, into a community setting, it could allow a more holistic and proactive approach to providing a health service, rather than a reductionist fixing the symptoms style approach.

(Slide 15) In conclusion occupational therapists view occupation as those entire activities that people do that give life meaning and determine who we are. Within the Child Health setting an occupational therapist could bring a perspective to the team that is child and family focused, context driven and focus’s on all aspects of the child and their attainment of early development. Therefore the role of an OT within the Caloundra community Child Health team would be extremely beneficial to the health and development of children within our region. Providing children and families with a more accessible and thorough service, that would help to alleviate the number of children with mild developmental delays and help set the child up to be an efficient learner in order to thrive in life.

Occupational therapy is important because we address the physical, cognitive, psychosocial and spiritual aspects of performance in a variety of contexts to support the engagement in everyday life activities that affect health, well-being and quality of life.

In finishing I am going to leave you with this quote from the American Occupational therapy Association. “Occupational therapy services are provided for the purpose of promoting health and wellness to those who have or at risk of developing illness, injury, disease, disorder, condition, impairment, disability, activity limitation or participation restriction”. Based on this it appears that there is a very genuine role for OT within the current Child Health team in Caloundra.

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